Showdown Looms as Child Health Bill Passes

The Senate, with an overwhelming bipartisan vote yesterday, sent President Bush a $35 billion expansion of the State Children's Health Insurance Program, setting up the biggest domestic policy clash of his presidency and launching a fight that will reverberate into the 2008 elections.

Bush has vowed to veto the measure, but he has faced strong criticism from many fellow Republicans reluctant to turn away from a popular measure that would renew and expand an effective program aimed at low-income children. Democratic leaders, while still as many as two dozen votes short in the House, are campaigning hard for the first veto override of Bush's presidency.

They secured a veto-proof majority last night in the Senate, with the 67 to 29 tally including "yes" votes from 18 of the 49 Republicans, including some of the president's most stalwart allies, such as Christopher S. Bond (Mo.), Kay Bailey Hutchison (Tex.) and Ted Stevens (Alaska). Democratic leaders are likely to send the measure to the White House next week, giving advocates a few more days to pressure Bush to sign it.

For Republicans, the issue is politically perilous. Every Senate Republican facing a difficult reelection bid bolted from Bush yesterday. Most House Republicans in swing districts abandoned him Tuesday when the House approved the bill 265 to 159. Those Republicans "took the vote that was easiest to explain," said House Minority Whip Roy Blunt (R-Mo.).

Even conservative Republicans pleaded with Bush to relent.

"I am very disappointed that before the administration even received the final language, their minds were apparently made up and a line was drawn in the sand opposing this compromise," said Sen. Pat Roberts (Kan.).

Rep. Chris Van Hollen (Md.), chairman of the Democratic Congressional Campaign Committee, vowed to make Bush's supporters pay a price at the polls next year, and he will have his share of targets. Republican Reps. Thelma Drake (Va.), Sam Graves (Mo.), John R. "Randy" Kuhl Jr. (N.Y.) and Joe Knollenberg (Mich.) all voted against the bill and are in the Democrats' cross hairs. In total, the DCCC will be targeting 25 Republicans over the issue, said spokeswoman Jennifer Crider.

"Anyone who votes in lock step with the president and against children's health, they are going to hear about it back home," Van Hollen said.

Already, advocates are mounting advertising and grass-roots campaigns to pressure Republican supporters of the president. Two advertisements -- one on television, another on the Internet -- castigate Senate Minority Leader Mitch McConnell (R-Ky.) for standing against the program's expansion. Sen. Charles E. Grassley (R-Iowa), a key backer, promised yesterday to mount his own campaign to persuade House opponents to change their position ahead of a vote to override a veto.

White House spokesman Tony Fratto said the bill's opponents have nothing to fear. "Good policy is good politics, and if members stand on principle, they'll be just fine," he said.

The House GOP offers the president his best chance to uphold his veto. There the bill attracted 45 Republicans, including reliable conservatives such as Don Young (Alaska) and Denny Rehberg (Mont.). But it still fell about two dozen votes short of the two-thirds majority needed to override a rejection by Bush.

Leading up to a possible veto, the DCCC is preparing advertisements, automated phone calls and e-mail blitzes aimed at Republicans who might change their votes on an override, said a Democrat familiar with the campaign.

But Democrats, and their Republican allies on the issue, made it clear that Bush's veto will not be the last word. They said that they will keep coming back to the bill every six weeks to three months until the White House relents or Republican opposition collapses.

"If the president refuses to sign the bill, if he says, with a veto, 'I forbid 10 million children in America to have health care,' this legislation will haunt him again and again and again," said House Speaker Nancy Pelosi (D-Calif.).

Yesterday's vote put Bush in a position he has never faced. The president has used his veto for only two issues in seven years in office: federal funding for stem cell research and constraints on his Iraq war policies. But on those issues, Bush retains strong Republican support and a coalition that unites social, economic and national security conservatives.

The children's health bill, in contrast, has the support of moderate Republicans and conservatives, business interests and even abortion opponents such as the Roman Catholic Church. The measure has the backing of the health insurance industry and children's and disease-control advocates, most of the nation's governors, AARP and the American Medical Association.

The compromise would expand the $5 billion-a-year program by an average of $7 billion a year over the next five years, for total funding of $60 billion over the period. That would be enough to boost enrollment to 10 million, up from 6.6 million, and dramatically reduce the number of uninsured children in the country, currently about 9 million, supporters say.

Bush and GOP leaders say that the measure would push millions of children already covered by private health insurance into publicly financed health care. They say it would also create an "entitlement" whose costs would outstrip the money raised by the bill's 61-cent increase in the federal tobacco tax.

The coalition backing the bill could also face risks after a veto. House Majority Whip James E. Clyburn (D-S.C.) said he would push Democrats to come back at Bush with a new version that adds vision-care coverage to the expanded coverage for dental and mental health and restores benefits for the children of legal immigrants.

But by adding benefits, especially for immigrant children, Democrats could lose support in the Senate.

Sen. Orrin G. Hatch (R-Utah), one of the compromise measure's strongest advocates, suggested that he would like to see Congress look for a compromise with the White House after a veto. "If we want to cover these kids and we've got a stultification of that effort, then we're going to have to do the best we can," Hatch said.

Democratic leaders are convinced that no such compromise is necessary. Health care is again rising as a concern among voters, they say, citing Democratic polls that show overwhelming support for expansion of the children's health insurance program. Bush's unpopularity will affect sentiment among those against a veto, they say.